As an Asian woman, there is a strange fine line of what it means to look well-nourished versus being too porky. It is not uncommon to have Asian mothers/grandmothers/aunties constantly hovering and pressuring young women to “Eat more, you too skinny!” but then in the next breath, exclaim “Don’t eat so much sweets! Your husband won’t like that big butt!”. This oxymoron of tough love can be very frustrating, not to mention demoralizing to any young woman.

The other day as I was helping my daughter get dressed for school, she asked me to buckle her belt “extra tight so my pants won’t fall off.”. I made a joke about her little skinny minnie butt and how she needed to eat more. As the words came out of my mouth, I started feeling guilty, wondering if I had started down a slippery slope of being one of those Asian moms who can’t make up their minds if they want their daughters to eat or not eat.

This paranoia got me thinking about a subset of patients that I periodically encounter in my clinic. About once a month, or maybe more frequently around the holiday season or following a long weekend, I end up seeing young female patients for an endocrine evaluation of “potential hormonal issue for weight gain or trouble losing weight.”

These women typically range from age 18-24 and are always accompanied by their mothers. Their stories are always remarkably similar. The young woman is usually in college or graduate school, typically has a history of being extremely fit/athletic in high school, and went off for school, returned home for the holidays/spring break/long weekend, and the parents are appalled by the amount of weight she has gained since the last time she was at home. Sometimes the young woman seems reluctant or embarrassed to be sitting in my office, sometimes they are on the verge of tears, and most often the mother of the patient appears to be the more distressed of the two. When I ask to speak with the young woman alone, I almost always get some variation of the story, “Things have been very stressful around midterms/finals/project due date, I haven’t been exercising as I used to, I tend to drink a little bit more alcohol at parties/eat a little bit more junk food.”

99% of the time, fortunately or unfortunately, I cannot find a straight-forward treatable endocrine diagnosis at the end of their visit. It’s the classic case of the dreaded “Freshmen 15”. I end up spending the majority of the time counseling the patient on physical activity, dietary changes, and lifestyle modification.

As I interact with these young women, I can’t help but reflect upon the relationships between mother and daughter. Aside from my patients, I certainly know many many women for which weight gain/loss is a very sensitive issue, especially if their mothers are nagging them about it. The question of who initiated the appointment always crosses my mind. Is the true purpose of the evaluation for the daughter or the mother? Is the mother or the daughter really hoping that it is just a “hormone imbalance issue” and not an overeating/body image issue? It is my impression after talking to these young women (and the mothers) that most of them know exactly why they’ve gained weight. Maybe both people sitting in the exam room across from me just want to hear me confirm what they’ve known in their hearts all along. As one of my colleagues pointed out to me, “Maybe the mother wants someone to tell her daughter to stop sitting on her butt, stop drinking so many empty calories, and start exercising again. And they feel more comfortable having you be the one telling their daughter that.”

I wonder, as a mother to a very beauty-conscious picky-eater with a giant sweet tooth, if one day she came home from college having gained 10-15 lbs over a span of three months, would I be able to sit down with her and have a loving honest conversation about her health? Would she be mad at me for even bringing it up? Would I have to resort to a “medical professional opinion”? I hope that as I grow as a mother, to be able to present myself as a good role model to my daughter and to let her know what it means to be healthy, beautiful and honest.